BACKROUND: Recent developments in modelling have made it easier to use muscle force predictions to augment clinical gait analysis and enhance clinical decision making. OpenSim claims to provide a straight forward, standardised pipeline (SimTrack) to predict muscle forces implemented in routine processing. This project aims to test SimTrack’s potential in the context of clinical gait analysis by developing a standardised protocol which compares predicted muscle forces with surface EMG at a range of walking speeds. METHODS: 10 healthy participants walked at 3 different speeds (comfortable, ±20%). Kinematics, kinetics and surface EMG of the lower limb were captured. Joint angles and ground reaction forces serve as inputs to predict muscle forces using computed muscle control (CMC) within SimTrack. Predicted muscle forces were compared with EMG to validate the model outputs. RESULTS: Agreement between force prediction and EMG varies between muscles. Some muscles show a general agreement and similar variation with walking speed, others show large unexpected differences between CMC outputs and observed EMG. DISCUSSION: These results suggest that this protocol is running in general. For most walking speeds, CMC muscle forces can be predicted within a timeframe appropriate for clinical purposes. However using the default settings, the model predictions do not agree with EMG measurements. Furthermore, during pilot testing of quicker walking speeds (up to +40%) CMC crashed due the chosen musculoskeletal model being too weak. These findings suggest the need of either different generic parameters or subject specific parameters to obtain valid results. Work is continuing to identify these.Listed In: Biomechanics, Gait, Other

Introduction: Running is a popular form of physical activity linked to various lower extremity injuries. A commonly used technique for injury prevention and rehabilitation is taping. There is considerable research investigating running biomechanics, however, there has been limited to no research examining the effects of gender, speed, and the type of tape used on two-dimensional lower extremity kinematics. Therefore, the purpose of this pilot study was to investigate the effects of gender, speed, and tape on two-dimensional lower extremity kinematics and stride characteristics during running.
Method: Eight healthy runners participated (4 males, 4 females). Taping interventions (Leukotape, Kinesio Tape, no tape) and speeds (2.35 m/s, 3.35 m/s) were randomized and lower extremity stride kinematics were obtained using the Peak Motus System at initial contact, midstance, and toe off of running. Comparisons were made using descriptive statistics.
Results: Females exhibited greater hip (FIC= 164.04+1.99°; MIC= 167.54+2.12°) and knee flexion (FIC= 167.73+0.93°; MIC= 170.42+1.65°; FPK= 142.83+1.28°; MPK= 146.35+1.21°), while males had greater ankle dorsiflexion (FIC= 88.60+1.00°; MIC= 84.14+1.08°) and plantarflexion (FTO= 51.90+1.01°; MTO= 55.99+0.825°). Females spent more time in support (FCT= 0.28+0.03s; MCT= 0.26+0.02s) while males spent more time in the air (FFT= 0.45+0.02s; MFT= 0.48+0.01s). Faster speed was associated with greater hip flexion and extension (SIC= 167.57+1.95°; FIC= 164.01+2.11°; STO= 197.14+1.23°; FTO= 201.28+0.74°), peak knee flexion (SPK= 145.39+1.82°; FPK= 143.79+2.39°), and less time during contact (SIC = 0.30+0.01s; FIC= 0.25+0.00s).
Conclusion: Gender and speed seem to have effects on lower extremity stride kinematics, whereas type of tape does not.Listed In: Biomechanics, Gait, Other

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.

The concept of a leaf spring structured midsole shoe (LEAF) is based on shifting the foot anteriorly during the first part of stance phase in heel-toe running. The aim of the current study is to analyze the effects of a LEAF compared to a standard foam midsole shoe (FOAM) on the foot kinematics in overground and treadmill running at two running speeds.
Nine male heel strikers ran on a treadmill with the LEAF and the FOAM at 3 and 4 m/s, each for 5 min. Furthermore, the participants performed with both shoes six runs each on a 40 m indoor track at running speeds of 3 and 4 m/s. For one stance phase the ground reaction forces were measured using a force plate imbedded in the track. Running speed and shoe order were randomized. Kinematics (VICON, 200Hz) and kinetics (AMTI, 1000Hz; only overground) were used to calculate the anterior shift of the foot, the foot ground angle at heel strike (FGA at HS) and the horizontal path of the center of pressure (COP).
The LEAF increases the anterior foot shift in treadmill and overground running at both running speeds compared to the FOAM, without changing the individuals’ strike pattern. Furthermore, the anterior foot shift affects the COP leading to an overall enlarged COP path. These findings indicate a benefit of the structured midsole on performance at least at moderate running speeds
Listed In: Biomechanics, Sports Science

For lower limb amputees graded walking imposes a high level of motor ability, due to the missing proprioceptive feedback of the limb, and the necessary compensation mechanisms. In order to facilitate gait a focus in prosthesis research is the development of the prostheses ankle joints from rigid to moveable. Therefore, the aim of this case study was to analyse the effects of three different prostheses with a rigid and a moveable ankle joint during graded walking of a unilateral amputee.
One male unilateral transfemoral amputee was recruited for this study and a comparison of following three prostheses (endolite, Germany) was performed: Elan (movable ankle joint with flexible resistance), Echelon (movable ankle joint with steady resistance) and Esprit (rigid ankle joint). Kinematic (12 cameras, Vicon, UK, 250 Hz) and kinetic (2 force plates, AMTI, MA, 1000 Hz) data were recorded during self-paced walking on a 6 m ramp, which was set to the inclinations of -12°, -4°, 0°, 4° and 12°. Following gait parameters, ground reaction forces, joint angles and joint moments were calculated.
Gait parameters, ground reaction forces and joint angles were marginally influenced by the different prosthetic designs, but major changes occurred on the joint moment level. The use of the rigid ankle prosthesis Esprit induced up to 10 times higher joint moments compared to the moveable ankle joint prostheses. This case study showed that a moveable ankle joint can reduce the joint moments during graded walking, which might be advantageous to use for transfemoral amputees in graded walking.Listed In: Biomechanics, Gait

INTRODUCTION: Workers in industry wear steel toe boots; however, these boots are inflexible and may restrict foot movement. Occupational kneeling is also associated with an increased risk of knee osteoarthritis. Examination of the effects of work boots in kneeling is needed to better understand potential injury risk. Therefore, the purpose of this study was to analyze the center of pressure (COP) at the knee during kneeling when shod and barefoot.
METHODS: Fifteen, young, healthy males completed five 10-second static kneeling trials in each condition. Lower body kinematics were obtained using the Optotrak system (Certus and 3020, NDI, Waterloo, ON, CA). Force data were measured from a force plate under the knee of the dominant leg (OR6-7, AMTI, Watertown, MA, USA).
The mean COP location was determined with respect to the medial tibial plateau (normalized to tibial width) and the tibial tuberosity (normalized to tibial length) for the medial/lateral and longitudinal directions, respectively.
RESULTS: COP was located more medially in the shod condition (34% (±10.6%) tibial width) compared to the barefoot condition (40% (±11.9%) tibial width) (p=0.0485). COP was located above the tibial tuberosity, with no difference between conditions (shod 11% (±3.2%) tibial length, barefoot: (7%) (±8.8%) tibial length) (p=0.97).
DISCUSSION: There is a difference in COP location in shod compared to barefoot kneeling. A COP location farther from the joint center of rotation, as occurred in the frontal plane of the shod condition, would increase the moment arm of the ground reaction force and thus the moment at the knee.
Listed In: Biomechanics

We investigated whether stability affects the learning and/or transfer of human postural control strategies. Subjects learned novel postural control strategies in a more stable standing configuration and then transferred to a less stable configuration, or vice versa. Initial learning was not affected by stability. However, transfer of learned control from one context to another was affected by the change in stability between contexts. These results suggest that in rehabilitation it is important to consider the context in which task learning occurs, as well as the context in which the task will be performed in the future.Listed In: Biomechanical Engineering, Biomechanics, Neuroscience

Following amputation, an amputee must learn to walk again using a prosthesis. A goal of prosthetic rehabilitation is to reduce and eliminate asymmetries between the prosthetic leg and sound leg which may decrease the negative effects of long term force and work demands on the sound leg. An amputee-specific physical therapy program provides structured motor learning to aid in developing proper gait mechanics. However, physical therapy is not standard of care for all individuals receiving their first prosthesis due to limited evidence showing improved gait. Thus, the purpose of this study was to determine whether amputees receiving physical therapy have better gait mechanics than those that do not. It was hypothesized that those who underwent an amputee-specific physical therapy program would display a more symmetrical gait pattern. Transtibial amputees walked overground at self-selected pace while kinetic (600Hz) and kinematic (60Hz) data were collected. The therapy group had previously received 2-3 therapy sessions per week for 3 months. Asymmetries were determined through dependent t-tests (α=0.05) comparing sound leg and prosthetic leg kinetic variables. Of the 23 kinetic variables tested, 17 variables showed significant difference between the sound leg and prosthetic leg for the group that did not receive the amputee-specific physical therapy. For the group that had previously received the therapy, only 4 variables showed differences between the sound and prosthetic leg. Thus, we showed that individuals partaking in amputee-specific physical therapy have a more symmetrical gait which results on less force and energy demands on the sound leg.Listed In: Biomechanics, Gait, Physical Therapy